Survey results on IOL explantation show shifting trends

San Francisco-Results of the most recent American Society of Cataract and Refractive Surgery (ASCRS)/European Society of Cataract and Refractive Surgeons (ESCRS) survey on foldable IOLs requiring explantation or secondary intervention indicate a shift in the leading causes for these procedures, said Nick Mamalis, MD, professor of ophthalmology and visual sciences, University of Utah School of Medicine, Salt Lake City.

He presented data from 2008, which represents the 11th year the ASCRS/ESCRS survey has been conducted. Surveys are submitted to Dr. Mamalis and colleagues at the Intermountain Ocular Research Center, University of Utah, through a project performed in conjunction with the ASCRS Cataract Clinical Committee.

Considering all submitted surveys, incorrect lens power no longer ranked as one of the top two leading causes for IOL explantation/exchange, he said. Instead, dislocation/decentration was by far the most common complication reported, followed by glare/optical aberrations.

"These results show that cataract surgeons are getting better at measuring IOL power and choosing the correct lens, but they are also a reminder about the importance of good surgical technique, including achieving an intact capsulorhexis, maintaining zonule integrity, and implanting the IOL completely in the bag with overlapping of the optic rim," Dr. Mamalis said.

When the data were analyzed with IOLs categorized based on style and material, the most common complications leading to explantation/secondary intervention varied depending on lens type. Of particular interest, hydrophilic acrylic (hydrogel) and multifocal IOLs diverged from the overall trends, he said. For the hydrogel IOLs, calcification/opacification accounted for virtually all explantations, whereas glare/optical aberrations was the most common complication associated with explanted multifocal IOLs.

"We are now seeing an increasing number of multifocal IOLs being explanted, probably because these types of lenses are being implanted more frequently," Dr. Mamalis said. "The importance of optical aberrations and glare as a reason for multifocal IOL explantation speaks to the importance of proper patient selection and thorough preoperative counseling when implanting these lenses."